Standard Option includes coverage for mental health and substance abuse treatments. Your cost-sharing responsibilities are no greater for these treatments than for other illnesses or conditions. Standard Option offers you the flexibility to choose to receive care by an in-network, Preferred provider or by an out-of-network, Non-preferred provider.
Outlined below is a summary of the mental health and substance abuse benefits provided under Standard Option. Please remember that all benefits are subject to the definitions, limitations, and exclusions defined in the 2009 Blue Cross and Blue Shield Service Benefit Plan brochure.
2009 Standard Option - Mental Health and Substance Abuse Benefits
What You Pay
| Services | Preferred Provider | Non-Preferred Provider * |
|---|---|---|
|
Inpatient Hospital — Precertification required |
$200 per admission copayment Unlimited days |
$400 per day copayment at Member hospitals and Non-member hospitals up to 100 days per calendar year for mental conditions 28 days per lifetime for substance abuse |
|
Outpatient Facility Care ** |
Subject to the calendar year deductible (Individual or Family) 15% of the Preferred Provider Allowance (PPA) |
Subject to the calendar year deductible (Individual or Family) 30% of the Plan Allowance (PA) at Member and Non-member facilities There is a 25-visit limit that is a combined maximum for all outpatient visits allowed per person per calendar year |
|
Inpatient Professional Care |
Subject to the calendar year deductible (Individual or Family) 15% of the Preferred Provider Allowance (PPA) |
Subject to the calendar year deductible (Individual or Family) 40% of the Plan Allowance up to 100 days per person per calendar year for mental conditions. You may also pay the difference between the Plan Allowance and the provider's charge when you use Non-participating physicians |
|
Outpatient Professional Care ** |
$20 copayment per visit |
Subject to the calendar year deductible (Individual or Family) 40% of the Plan Allowance There is a visit-limit of 25 combined maximum for all outpatient visits allowed per person per calendar year. |